Provider Demographics
NPI:1710926068
Name:NORDSTROM, KAREN (RN PC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:NORDSTROM
Suffix:
Gender:F
Credentials:RN PC
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Mailing Address - Street 1:26 QUEEN STREET, GROUND FLOOR
Mailing Address - Street 2:UMASS MEMORIAL MED CTR, AMBULATORY PSYCHIATRY SERVICE
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610
Mailing Address - Country:US
Mailing Address - Phone:508-334-2537
Mailing Address - Fax:508-334-4320
Practice Address - Street 1:26 QUEEN STREET, GROUND FLOOR
Practice Address - Street 2:UMASS MEMORIAL MED CTR, AMBULATORY PSYCHIATRY SERVICE
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610
Practice Address - Country:US
Practice Address - Phone:508-334-2537
Practice Address - Fax:508-334-4320
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2014-10-17
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Provider Licenses
StateLicense IDTaxonomies
MA106598364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANS 0220Medicare PIN